Research Shows Women With Diabetes Are 'Less Likely To Breastfeed'

Dr. Enrique Jacome

Breastfeeding is considered beneficial for both mother and baby. Breast milk is believed to give infants the nutrients they need, while breastfeeding has been associated with a lower risk of breast and ovarian cancers. But new research suggests that women diagnosed with diabetes before or during pregnancy are less likely to initiate or continue breastfeeding their newborns, compared with women without diabetes.

The research team, led by Dr. Reena Oza-Frank of the Center for Perinatal Research at Nationwide Children's Hospital in Columbus, OH, recently published their findings in the journalPublic Health Nutrition.

Past research has indicated that infants born to women withdiabetes during pregnancy, known as gestational diabetes, are more likely to develop hypoglycemia (low blood sugar) immediately after birth, as well as type 2 diabetes or obesity later in life. But Dr. Oza-Frank says breastfeeding can help reduce such risks.

The team set out to see whether pre-pregnancy diabetes or gestational diabetes influence breastfeeding initiation or the overall duration a mother breastfeeds.

Women with pre-pregnancy or gestational diabetes 'need additional support'

For their study, the researchers looked at data from the 2009-2011 Pregnancy Risk Assessment Monitoring Program (PRAMS) - a surveillance project of the Centers for Disease Control and Prevention (CDC).

Of almost 73,000 women, the researchers identified 8.8% who had gestational diabetes and 1.7% who had pre-pregnancy diabetes.

In order to ensure that any differences in breastfeeding initiation or continuation could be attributed solely to diabetes, the team accounted for 16 influential factors, including age, income and ethnicity.

They found that women with gestational diabetes and those without diabetes were equally as likely to start breastfeeding. However, women with gestational diabetes were more likely to breastfeed for at least 2 months less than healthy women.

Women with pre-pregnancy diabetes were less likely to start breastfeeding than those with gestational diabetes or without diabetes, but those who did breastfeed continued to do so for approximately the same duration as women with gestational diabetes.

Commenting on the team's findings, Dr. Oza-Frank says:

"We found that women with pre-pregnancy diabetes had the lowest breastfeeding initiation and continuation rates. However, women with gestational diabetes also had low continuation rates.

This study indicates that women with pre-pregnancy diabetes need additional support both initiating and continuing breastfeeding, and women with gestational diabetes need additional support continuing breastfeeding."

Prenatal education for diabetic women could ease breastfeeding concerns

The researchers also found that 30% of women with pre-pregnancy diabetes said their illness and medication use deterred them from breastfeeding, indicating that diabetes and its treatment has a direct influence on women's breastfeeding decisions.

Many of the women with diabetes said they simply did not want to breastfeed or felt that they could not supply enough milk for their infants - reasons that were also cited among women without diabetes.

Dr. Oza-Frank says that women with pre-pregnancy or gestational diabetes could have their breastfeeding concerns put to rest by having prenatal education about how their illness may influence their infant's health and how breastfeeding may help reduce these risks.

"Breastfeeding intention is often the strongest predictor of breastfeeding initiation, and by establishing intent early in pregnancy, successful initiation is more likely," she adds. "Lactation consultants are an excellent resource and support for breastfeeding moms both immediately after delivery and beyond."

The researchers plan to further their research in this field by assessing exclusive breastfeeding rates for up to 6 months among women with pre-pregnancy and gestational diabetes. They also plan to look at the women's breastfeeding patterns in the first year of their infant's life, as well as the introduction of bottle-feeding and solid foods.

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Study Shows Double Mastectomy 'Not Necessary' For Most Women

Dr. Enrique Jacome

Following a breast cancer diagnosis, many women opt for removal of both breasts, called a double mastectomy. But new research from the University of Michigan Comprehensive Cancer Center suggests around 70% of women do so, even though they face a very low risk of cancer in the healthy breast.

The researchers, led by associate professor Sarah Hawley, publish their findings in JAMA Surgery. According to the ACS, 235,030 individuals in the US will be diagnosed with breast cancer this year and 40,430 will die from the disease.

The team notes that women with a family history of breast or ovarian cancer, or with mutations in the BRCA1 or BRCA2 genes, are typically advised to consider a double mastectomy since they have a higher risk of developing cancer in the healthy breast.

However, only around 10% of all women diagnosed with breast cancer fall into this category; the other women are unlikely to develop a second cancer in the other breast.

Because recent studies have shown that women are increasingly opting for this surgery, the researchers say the question of whether such patients are receiving overtreatment is valid. To further investigate, they assessed 1,447 women who had been treated for breast cancer and had not had a recurrence. In total, they found that 8% of the women had a double mastectomy and 18% considered it.

Surgeons should be aware of how patient worry affects decision-making

Of the study participants, around 75% reported that they were very worried about their cancer recurring, and those who opted for a double mastectomy were much more likely to report concern about recurrence.

However, the researchers point out that being diagnosed with cancer in one breast does not increase the likelihood of it occurring in the other breast for most women.

"Women appear to be using worry over cancer recurrence to choose contralateral prophylactic mastectomy," says Hawley. "This does not make sense, because having a non-affected breast removed will not reduce the risk of recurrence in the affected breast."

After assessing family history of breast and ovarian cancer and any genetic testing results, the researchers found that among the women who had both breasts removed, around 70% did not have a family history or a positive genetic test.

Many of these women, however, could have received breast-conserving lumpectomy, which is a smaller operation with fewer complications and an easier recovery.

Of the women who received a double mastectomy, most also had breast reconstruction, and women who need to undergo chemotherapy or radiation therapy after their surgery could have prolonged recoveries.

Interestingly, women with higher levels of education and those who underwent an MRI test prior to surgery were more likely to opt for having both breasts removed, with concern over recurrence being the biggest factor in deciding to have the surgery.

Hawley notes, however:


"For women who do not have a strong family history or a genetic finding, we would argue it's probably not appropriate to get the unaffected breast removed."

The team says that, while it is important to educate women about risks and benefits of surgery to remove both breasts, surgeons should also be aware of how a patient's worry over recurrence could affect her decision.

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Research Shows Contraception Changes Affect Sexual Relationships

Dr. Enrique Jacome

Women's sexual satisfaction in long-term heterosexual relationships may be influenced by changes in hormonal contraceptive use, research from the University of Stirling shows.

The study, published in Psychological Science, a journal of the Association for Psychological Science, was carried out by researchers from the universities of Stirling, Glasgow, Newcastle, Northumbria and Charles University in Prague.

The team looked at a sample of 365 couples, and investigated how satisfaction levels - in both sexual and non-sexual aspects of long-term relationships - were influenced by women's current and historical use of hormonal contraception.

"Our findings showed women who had met their partner while taking the pill and were still currently taking it - as well as those who had never used the pill at any point - reported greater sexual satisfaction than those women who had begun or stopped using the pill during the course of the relationship," says lead researcher Craig Roberts from Stirling's Division of Psychology.

"In other words, the congruence of women's pill use throughout the relationship had a greater influence on sexual satisfaction levels than either simply being on the pill or not being on the pill."

The team found there was no difference in the non-sexual aspects of relationship satisfaction between the groups of women. Additionally, women's history of pill use was also found to make no difference to their male partners' relationship satisfaction in both sexual and non-sexual contexts.

"Previous research has shown that hormonal contraceptives, such as the pill, subtly alter women's ideal partner preferences and that often women who are using the pill when they meet their partner find the same partner less physically attractive when they come off the pill," says Roberts.

"Our new results support these earlier findings but, crucially, they also point to the impact a change in hormonal contraceptive use during a relationship - either starting or stopping - can have on a woman's sexual satisfaction with her partner."

According to Roberts, "The pill has been a tremendously positive social force, empowering women and giving them greater control over their lives, but there is also a lot of controversy surrounding the question of whether hormonal contraceptives alter women's libido and sexual satisfaction."

"These results show that examining current use is not enough to answer this question. What seems to be important is whether a woman's current use matches her use when she began the relationship with her partner. We hope our results will help women understand why they might feel the way they do about their partner when they change use," Roberts concludes.

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New Study Shows Breastfeeding, Birth Control Pills May Reduce Risk Of Ovarian Cancer

Dr. Enrique Jacome

Mutations in the BRCA1 and BRCA2 genes are known to increase the risk of female breast and ovarian cancers. But a new study published in the Journal of the National Cancer Institute finds that breastfeeding, taking oral contraceptives and tubal ligation may reduce ovarian cancer risk for women with these mutations.

The BRCA1 and BRCA2 genes are responsible for producing tumor suppressor proteins in the body. These proteins help repair damaged DNA and, in turn, make sure a cell's genetic material is stable.

A mutation or alteration in either of these genes means proteins are not produced or are impaired; therefore damaged DNA may not be repaired correctly. This can lead to further genetic impairments in cells, which can lead to cancer development.

Women who inherit mutations in the BRCA1 or BRCA2 genes are much more likely to develop breast and ovarian cancers.

According to the National Cancer Institute, mutations in either gene account for approximately 15% of all ovarian cancers. Around 39% of women who inherit a BRCA1 mutation and 11-17% who inherit a BRCA2 mutation will develop ovarian cancer by the age of 70.

The researchers of this latest study, led by Timothy R. Rebbeck, PhD, of the Abramson Cancer Center at the University of Pennsylvania's Perelman School of Medicine, say past studies have suggested that certain factors - such as smoking and alcohol consumption - may modify the risk of ovarian cancer in women with BRCA mutations.

However, they note that many of these studies "are of variable quality, and it remains unclear which of these may be of value in clinical risk assessment."

'Heredity is not destiny'

To gain a better insight into modifiable risk factors for ovarian cancer in BRCA mutation carriers, the research team analyzed 44 peer-reviewed studies that they deemed as having "predefined quality criteria."

They found that women with BRCA1 mutations who breastfed or who had tubal ligation - a form of birth control in which the fallopian tubes are blocked, tied or cut - had a much lower risk of developing ovarian cancer, compared with women who did not breastfeed or have tubal ligation.

There was no relationship found between breastfeeding and tubal ligation, and reduced risk of breast cancer.

In addition, they found that women with BRCA1 or BRCA2 mutations who used oral contraceptives had a significantly lower risk of ovarian cancer, compared with women who did not use birth control pills.

According to the researchers, the analysis also helped pinpoint factors that may raise cancer risk among women with BRCA mutations. For example, they found that smoking increased the risk of breast cancer for women with a BRCA2 mutation.

Commenting on the team's findings, Rebbeck says:

"Our analysis reveals that heredity is not destiny, and that working with their physicians and counselors, women with BRCA mutations can take proactive steps that may reduce their risk of being diagnosed with ovarian cancer.

The results of the analysis show that there is already sufficient information indicating how some variables might affect the risk of cancer for these patients."

Although the researchers found that oral contraceptives may reduce the risk of ovarian cancer, they note that the link between birth control pills and breast cancer was "ambiguous." Past research has suggested that oral contraceptives increase the risk of breast cancer.

Therefore, the team notes that women should talk to their health care providers and weigh up the potential benefits against potential risks of birth control pills.

The investigators say that more research is needed before any conclusions can be made from their findings, but they point out that their study may help shed light on potential non-surgical options for women at risk of breast and ovarian cancers.

"Patients deserve better cancer-risk reduction options than surgically removing their healthy breasts and ovaries," says study co-author Dr. Susan Domcheck, of the Basser Research Center for BRCA at the University of Pennsylvania.

"It's imperative that we continue examining and building upon past research in this area so that we can provide BRCA mutation carriers with options at every age and at every stage of their lives."

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Research Shows Women Who Consume High-Protein Breakfasts May Decrease Their Risk For Diabetes

Dr. Enrique Jacome

In healthy individuals, the amount of glucose, or sugar, in the blood increases after eating. When glucose increases, levels of insulin increase to carry the glucose to the rest of the body. Previous research has shown that extreme increases in glucose and insulin in the blood can lead to poor glucose control and increase an individual's risk of developing diabetes over time. Now, a University of Missouri researcher has found that when women consumed high-protein breakfasts, they maintained better glucose and insulin control than they did with lower-protein or no-protein meals.

"For women, eating more protein in the morning can beneficially affect their glucose and insulin levels," said Heather Leidy, an assistant professor of nutrition and exercise physiology. "If you eat healthy now and consume foods that help you control your glucose levels, you may be protecting yourself from developing diabetes in the future."

Kevin Maki, of Biofortis Clinical Research, completed the study in collaboration with Leidy. They studied women aged 18-55 years old who consumed one of three different meals or only water on four consecutive days. The tested meals were less than 300 calories per serving and had similar fat and fiber contents. However, the meals varied in amount of protein: a pancake meal with three grams of protein; a sausage and egg breakfast skillet with 30 grams of protein; or a sausage and egg breakfast skillet with 39 grams protein. Researchers monitored the amount of glucose and insulin in the participants' blood for four hours after they ate breakfast.

"Both protein-rich breakfasts led to lower spikes in glucose and insulin after meals compared to the low-protein, high-carb breakfast," Maki said. "Additionally, the higher-protein breakfast containing 39 grams of protein led to lower post-meal spikes compared to the high-protein breakfast with 30 grams of protein."

These findings suggest that, for healthy women, the consumption of protein-rich breakfasts leads to better glucose control throughout the morning than the consumption of low-protein options, Leidy said.

"Since most American women consume only about 10-15 grams of protein during breakfast, the 30-39 grams might seem like a challenging dietary change," Leidy said. "However, one potential strategy to assist with this change might include the incorporation of prepared convenience meals, such as those included in this study."

Leidy said the study provides a good model to initially examine the effect of higher-protein breakfasts on glucose and insulin responses since only healthy, non-diabetic women with appropriate glucose control were included in the study. Based on the study's findings, the researchers are hopeful that the consumption of protein-rich breakfasts also would benefit individuals with pre-diabetes, although future research is needed to confirm.

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Study Confirms Yoga Keeps Expectant Moms' Stress At Bay

Dr. Enrique Jacome

Yoga could reduce the risk of expectant mothers developing anxiety and depression, according to the first study on this subject. Stress during pregnancy is related to negative outcomes for both mother and child. 

Premature birth, low birth weight and increased developmental and behavioral problems in the child as a toddler and adolescent have all been linked to stress. High levels of anxiety during pregnancy can also lead to postnatal depression, which in turn is linked to risk of the mother developing depression in later life.

"There is a growing body of evidence that maternal antenatal anxiety may increase the risk of preterm delivery and the likelihood of giving birth to a low birth weight child," says James Newham, who carried out the research as a PhD student at Tommy's Maternal and Fetal Health Research Centre at the University of Manchester in the UK.

"If we can reduce these risk factors, and perhaps reduce the rate of postnatal mood disorders in mothers and negative health outcomes in their offspring, then that can only be a good thing."

Yoga is often recommended to pregnant women by medical professionals on the assumption that it may help in reducing stress, but this has never been put to the test, scientifically.

"It is surprising this has never been looked at before. We have long believed that it works but no research had been done to back up the theory," says Dr. Newham.

"We have now gone some way to prove that it can help," he confirms. "It was not a small effect either. This has the potential to really help mothers who are feeling anxious about their pregnancy."

Dr. Newham and his colleagues studied 59 women who were pregnant with their first child. The researchers asked these expectant moms to self-report their emotional state throughout the yoga course.

One session of yoga reduces anxiety 'by a third'

The women were split into groups, some of whom took part in a weekly yoga session for 8 weeks, while the others had normal prenatal treatment.

From analyzing questionnaires completed by the participants - and performing stress hormone assessments on the yoga group - the researchers calculated that a single session of yoga reduced self-reported anxiety by a third and stress hormone levels by 14%.

The stress-defeating powers of yoga also did not diminish across the duration of the 8-week course. The researchers found that the participants' stress and anxiety scores at the end of the course were similar to those reported in the first week of the intervention.

Prof. John Aplin, one of the senior investigators of the study - which is published in the journal Depression and Anxiety - and a yoga teacher himself, says:

"The results confirm what many who take part in yoga have suspected for a long time. There is also evidence yoga can reduce the need for pain relief during birth and the likelihood for delivery by emergency cesarean section.
Perhaps we should be looking at providing yoga classes on the [British National Health Service]. It would be relatively cheap to implement, could help mothers and their children be healthier, as well as reducing the costs of longer term health care."

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